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Acupuncture as Part of the Western Medical System

By Don Thompson, LAc

As acupuncture continues to grow in this country, hospitals and Western health institutions will increasingly incorporate acupuncturists as staff members of the institutions or as contractual providers.

This article will attempt to identify key elements to a successful union of Eastern and Western medicine.

First and foremost, know the laws that govern acupuncture in the state in which you work. This will affect your scope of practice within the hospital, and will always be in discussions with hospital administrators, physicians and hospital attorneys when establishing the role of acupuncture within an institution. Also, be familiar with the regulations that govern the hospital or institution. For instance, who does the acupuncturist report to? In hospitals, everyone reports to someone.

If you are permitted to see hospitalized patients, there is information you need to know prior to treating the patient. This includes assuring that there is a written order by the attending physician for acupuncture services. Also, you will want to make sure your patient understands that the payment for your services is an out-of-pocket expense if his or her insurance doesn't cover acupuncture, and that you are a contract employee of the hospital.

Another crucial element to remember when providing acupuncture services in a hospital setting is to realize that your patients will tend to be more ill than most patients you encounter in a traditional private practice. These patients tend to have more complicated medical histories and often are on several medications. Talk with the patient's nurse prior to treatment to inquire on the patient's status, change in medication(s), and other pertinent information. Acupuncture is often thought of as the last report and hope within a system of quite sick patients. Therefore, it's imperative to be familiar with CPR and emergency procedures that are established in the hospital or institution. In my hospital-based outpatient practice, I recently sent three patients to the emergency room via ambulance. Two cases were for chest pains, which started during acupuncture treatment; the third case was a patient who suffered from a reaction to his medications, which mimicked the symptoms of a stroke.

Talk the language. Remember: acupuncturists are still guests in Western medicine's home. We need to play by "their" rules, at least for the time being. Learn as much Western medicine as you can. Spend time reading journals in the hospital's medical library. Go to the grand rounds of various departments. Spend time with pharmaceutical representatives to learn about the medications they're touting. If you don't know much about your patient's Western diagnosis, learn about it - especially before communicating with others on your patient's care. Many folks within Western medical settings don't believe in qi. Limit your use of TCM terminology until you've gained the respect of your hosts.

Acupuncturists can expand their credibility in hospital settings in several ways. Ask to be part of multidisciplinary teams such as those that exist at pain medicine conferences. If this doesn't exist, approach one of the attending physicians to see if he or she would be interested in forming such a team. These teams exist as a forum for physicians to discuss difficult cases with other professionals, oftentimes outside of the physician's specialty. Also, provide in-service conferences to physicians, nurses, physician assistants and medical residents if you're in a teaching hospital. This provides a forum in which you can show what you know about Western medicine, and that you have a different approach to many Western problems that are not often treated with Western therapies efficiently or effectively. It allows for an exchange of dialogue. Don't cut corners in preparing for these presentations.

You may have the opportunity to participate in research projects. By all means, participate, and remember that you're the expert when it comes to the acupuncture portion of the protocol. Insist on being a part of the initial meetings when discussing the research project and how acupuncture will be tested.

Last but not least is the area of compensation. There are two main forms of compensation in these settings. One is by contractual agreement, whereby the acupuncturist rents space in the hospital and pays a percentage of his or her fees to the hospital. Areas of clarification include room rental, linens, use of the receptionist/staff, needles, and malpractice insurance. Most hospitals will require you to carry professional liability in the amount of $1 million/$3 million.

If you're an employee of the hospital, it is essential to keep a few key things in mind when negotiating your salary. Compare your duties and patient responsibilities with others in the hospital setting. Oftentimes, acupuncturists have many of the same duties and responsibilities as physicians. There's only one chief in this tribe, so don't expect to be treated the same - especially when it comes to salary. Realistically, most acupuncturists in hospitals will probably function at the same level as a mid-level practitioner, such as a physician assistant or physical therapist. Average salaries in those fields range from $45,000 to $65,000, depending on specialty and location. You may have trouble obtaining that salary if there isn't a demand for your services, or if patients can't pay for acupuncture services.

These are exciting times for everyone in health care today. Acupuncture will continue to grow and gain acceptance, not just with the general public, but also within the Western health care community. Let's prepare ourselves for that challenge.

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